Increase of resting levels of superoxide anion in the whole blood of patients with decompensated liver cirrhosis.

The aim of this study is to investigate the relationship between the resting level of superoxide anion (O2.) and liver cirrhosis (LC). The resting levels of superoxide anion in the whole blood of healthy controls and patients with compensated or decompensated LC were measured, by an ultra-sensitive chemiluminescence (CL) analyzer and lucigenin amplification. The assay system can be performed in the absence of leukocyte isolation and stimulant administration. The results showed that the blood CL levels of compensated cirrhotic patients (381.0 +/- 201.5 counts/10 s, mean +/- SD, n = 24) were similar to that of healthy controls (467.9 +/- 299.5 counts/10 s, n = 24). However, the blood CL levels of decompensated cirrhotic patients (2083.5 +/- 1462.4 counts/10 s, n = 24) were significantly greater than that of healthy controls and patients with compensated LC (both p < .001, Student's t-test). The correlation analysis revealed that the blood CL levels in cirrhotic patients were significantly correlated with serum concentrations of albumin (r = -0.65, p < .001) and total bilirubin (r = +0.42, p < .005). However, there was no significant correlation between the blood CL levels and serum levels of transaminases (GOT and GPT). These results suggest that blood levels of superoxide of decompensated cirrhotic patients were greater than those of healthy controls or compensated cirrhotic patients. Moreover, the increase of blood levels of superoxide in decompensated cirrhotic patients is related to the impairment of liver function but not to the inflammation.

Significance of c-erbB-2 expression in normal and neoplastic epithelium of biliary tract.

There were few, but conflicting, reports dealing with the clinical significance of c-erbB-2 in biliary tract cancer. We evaluated the expression of c-erbB-2 in normal epithelium of bile ducts (n = 46), gallbladder cancer (n = 11), carcinoma of the ampulla of Vater (n = 18), and intrahepatic cholangiocarcinoma (CC) (n = 18). c-erbB-2 protein is present in 63% (29/46) of surface epithelium in large and septal bile ducts, but not in peripheral small ducts. Overexpression of the gene product was found in 27.8% (5/18) of intrahepatic CC, 27.8% (5/18) of carcinoma of the ampulla of Vater, and 63.6% (7/11) of gallbladder cancer. But, there was no c-erbB-2 overexpression in the hyperplasia or atypical hyperplastic bile duct epithelium (p = 0.002). In terms of prognostic implication, expression of c-erbB-2 did not correlate to the histopathological grade (p = 0.60) and tumor stage (p = 0.63). The results indicate that c-erbB-2 protein may play some roles in physiology of normal bile ducts. Overexpression of the gene product occurs in one forth to about two thirds of carcinoma of biliary tract, and may be used as phenotypic marker for neoplastic transformation. However, the gene product may not be important in the aggressive behavior of tumor.

Percutaneous choledochoscopic biliary tract stone removal: experience in 645 consecutive patients.

Our experience in non-operative retrieval of biliary tract stones through PTCS (percutaneous transhepatic cholangioscopy, n = 103) and POC (post-operative choledochoscopy, n = 542) plus the use of Dormia basket and EHL (electrohydraulic lithotripsy) is presented. The results of transhepatic and T-tube routes are compared, with emphasis on the technical difficulties encountered. The success rates were 96% and 97% in POC and PTCS, respectively. No mortality was related to these procedures. Intrahepatic duct angulation and stricture were the factors most often responsible for failure. Postoperative choledochoscopic stone removal is safe and the method of choice for retained biliary tract calculi, while PTCS is highly indicated for those high-risk patients with or without previous biliary surgery. POC and PTCS have, therefore, their own indications and differ in their clinical applications.

Bilateral hepatic duct decompression via a single percutaneous tract using a 'mother-baby' drainage catheter.

Decompression of the right and left hepatic ducts using a 'mother-baby' self-made drainage system via a single percutaneous tract was performed successfully in 15 of 21 patients with benign (n = 4) and malignant (= 17) hilar obstruction. The 'mother-baby' drainage system was composed of an 18 F catheter placed through the right hepatic duct into the distal common bile duct which was designated as the 'mother' catheter, while a second 10 F baby catheter was placed through the first catheter into the left hepatic ducts. This was achieved by a three-stage procedure: (1) percutaneous transhepatic biliary drainage; (2) balloon dilatation of the tract; and (3) intubation of the contralateral hepatic duct and placement of the 'mother-baby' drainage catheters. The mean interval of stent clogging was 5 months, with a range of 2-9 months. In 12 malignant cases, average survival time was 9.8 months. The technique avoided a second percutaneous hepatic puncture in centrally obstructing lesions and afforded bilateral biliary decompression.

Treatment of bleeding peptic ulcer by bilateral truncal vagotomy via a transpleural thoracoscopic approach and laparoscopic pyloromyotomy.

Six cases of recurrent bleeding duodenal ulcer were treated by bilateral truncal vagotomy via a right transpleural thoracoscopic approach and laparoscopic pyloromyotomy at Tainan Municipal Hospital. The vagus nerves were completely transected, which was proved by pathology. Basal acid output and insulin-stimulated maximum acid output were reduced by 68%-77% and 87%-92%, respectively, after vagotomy. On the other hand, there was no delay in gastric emptying on the basis of either patients' complaints or an upper gastrointestinal series of x-rays. Transpleural thoracoscopic bilateral truncal vagotomy and laparoscopic pyloromyotomy are safe, effective and offer more complete transection of the vagus nerves in treatment of complicated peptic ulcer. In addition, this new technique provides shorter hospitalization and an earlier convalescence.

Xanthogranulomatous cholecystitis: a complication of metallic biliary stent placement.

We present a case of 70-year-old female patient who was admitted due to progressive jaundice. Our clinical impression of cholangiocarcinoma (Klatskin tumor), was confirmed by ultrasound, abdominal CT scan, and percutaneous transhepatic cholangiography. Two self-expanding metallic stents were placed in both intrahepatic ducts through a single transhepatic tract. After successful biliary stenting, the jaundice subsided and she was discharged as improved. However, progressive right upper quadrant pain was noted a few days after discharge and persisted for about 5 months, thus the was readmitted. During admission, she was febrile, exhibiting leukocytosis, with clinical signs of impending septic shock. Gallbladder empyema with hilar cholangiocarcinoma were diagnosed. Percutaneous transhepatic cholecystotomy and drainage (PTCCD) was done to alleviate the symptoms and cholecystectomy was performed thereafter. Pathologic report was compatible with xanthogranulomatous cholecystitis. Post-operative recovery was fair at follow-up examination.

Spontaneous perforation of the left hepatic duct--a case report.

We report on a patient with spontaneous perforation of the left hepatic duct who presented with abdominal pain, jaundice and fever. The correct diagnosis was not established until extravasation of contrast medium from the left hepatic duct, as demonstrated by the cholangiogram, was observed. The patient developed two bile-stained intraperitoneal encapsulated fluid collections, which were diagnosed by ultrasonography, and high bilirubin levels in the fluid aspirated from the encapsulations, which were also found at operation. Closure of the perforation with sutures, decortication of the encapsulations and choledocholithotomy for stone extraction with T-tube insertion were performed. Recovery was complete at follow-up examinations.

Pre-operative staging of recto-sigmoid colon carcinoma by upper gastrointestinal endoscopic ultrasonography.

BACKGROUND/AIMS: To assess the accuracy of a new generation endoscopic ultrasonography (EUS)(GF-M200) in pre-operative staging of recto-sigmoid colon carcinoma invasion and lymph node metastasis. METHODOLOGY: Seventy-three patients with biopsy proven colon cancer were included in this study. These comprised 60 patients with rectal carcinoma and 13 patients with sigmoid carcinoma. All patients were pre-operatively examined by EUS. Pathological findings of the depth of tumor invasion and presence of lymph node metastasis were correlated with EUS. RESULTS: EUS has an overall accuracy rate of 89% in staging of recto-sigmoid cancer. The diagnostic accuracy rate was 83% for T1, 83% for T2, 93% for T3, and 71% for T4. Understaging and overstaging occurred in 6% and 6%, respectively. In determining lymph node metastasis, the overall accuracy rate was 77%, with a sensitivity and specificity rate of 77% and 76%, respectively. CONCLUSIONS: EUS is a valuable staging modality in the staging of the depth of tumor invasion, not only for rectal carcinoma but also for tumors located at the sigmoid colon.

Laparoscopic finding and imaging of the iatrogenic duodenal intramural hematoma.

Intramural duodenal hematoma is rarely seen in adults and may occur as an iatrogenic complication of endoscopic injection for peptic ulcer treatment. In the appropriate clinical setting, the diagnosis is easy with its ultrasonography and computed tomography characteristic findings. In one of our patients, UGI study revealed duodenal obstruction, bowel related lesion in sonography and hyperdense mass lesion in computed tomography. Clinical presentation of severe vomiting and epigastralgia were noted. Laparoscopy confirmed the location of the hematoma and subsequent evacuation was performed. The symptoms were relieved after the operation and a follow-up sonography demonstrated the regression of the duodenal hematoma.

The accuracy of endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, computed tomography, and transabdominal ultrasound in the detection and staging of primary ampullary tumors.

BACKGROUND/AIMS: To compare the accuracy between EUS (endoscopic ultrasound), ERCP (endoscopic retrograde cholangiopancreatography), CT (computed tomography), and transabdominal US (ultrasound) in the detection and staging of primary ampullary tumors. We will also try to discuss the influence of endobiliary stent on EUS in staging ampullary tumors. METHODOLOGY: Twenty-one patients with ampullary tumors were evaluated by EUS, ERCP, CT, and US before operation. The accuracy was assessed with TNM staging and compared with the surgical-pathological findings. RESULTS: EUS was superior to CT and US in detecting ampullary tumors, but EUS and ERCP are of similar sensitivity (EUS 95%, ERCP 95%, CT 19%, US 5%). EUS was superior to CT and US in T staging (EUS 75%, CT 5%, US 0%) and detecting lymph node metastasis (EUS 50%, CT 33%, US 0%) of ampullary tumors. The accuracy of EUS in T and N staging of ampullary tumors tended to be decreased in the presence of endobiliary stent (stenting: T 71%, N 75%; nonstenting T 83%, N 100%), but there was no statistical significance. CONCLUSIONS: EUS was superior to CT and US in assessing primary ampullary tumors, but it was not significantly superior to ERCP in detecting ampullary tumors. The presence of endobiliary stent may decrease the accuracy of EUS in staging ampullary tumors.

Rapid diagnosis of choledocholithiasis using biochemical tests in patients undergoing laparoscopic cholecystectomy.

BACKGROUND/AIMS: The present study was designed to identify the biochemical tests which could detect the presence of common bile duct stones in patients with symptomatic gallstones, without other invasive investigations. The usefulness of biochemical tests may reduce the necessity of endoscopic retrograde cholangiopancreatography prior to laparoscopic cholecystectomy. METHODOLOGY: 3000 patients with symptomatic laparoscopic cholecystectomy scheduled for laparoscopic cholesystectomy were included in the study. 458 patients (201 men, 257 women; mean age, 57.7 +/- 14.6 yrs) were examined with endoscopic retrograde cholangiopancreatography for suspected common bile duct stones. The serum tests for liver function, including a measurement of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, direct bilirubin, gamma-glutamyltransferase and albumin were obtained on admission prior to the ultrasonography, and the endoscopic retrograde cholangiopancreatography. RESULTS: The six significant factors, including alkaline phosphatase, direct bilirubin, total bilirubin, aspartate aminotransferase, alanine aminotransferase and gamma-glutamyltransferase were identified by the univariate analysis and the multivariate logistic regression analysis which identified alkaline phosphatase and gamma-glutamyltransferase, as the two significant independent factors. A statistical model was developed with a formula of [formula: see text] A curve of receiver operating characteristics was constructed to identify an alkaline phosphatase level greater than 300 U/L or a gamma-glutamyltransferase level greater than 420 mU/mL which would have both higher sensitivity and specificity. CONCLUSIONS: Biochemical tests can be a significant aid to the clinician's decision-making when predicting the presence of common bile duct stones in patients with gallstones.

Palliative percutaneous transhepatic gallbladder drainage of gallbladder empyema before laparoscopic cholecystectomy.

BACKGROUND/AIMS: This study is conducted to evaluate the feasibility of percutaneous transhepatic gallbladder drainage prior to laparoscopic cholecystectomy for the treatment of gallbladder empyema. We also determine the sonographic findings, causative organism, clinical signs and symptoms, laboratory data, associated underlying medical disorders and the complications related to both cholecystostomy and laparoscopic cholecystectomy. METHODOLOGY: One hundred and forty-five cases of gallbladder empyema were included in this study which was composed of 80 males and 65 females, aged 22-94 years with a mean age of 71-years. All patients underwent percutaneous transhepatic gallbladder drainage under ultrasound and fluoroscopic guidance, and laparoscopic cholecystectomy was carried out thereafter. We analyzed the clinical presentations (signs, symptoms, laboratory and ultrasonographic findings, concomitant medical disorders), causative organisms and the complications related to percutaneous cholecystostomy and laparoscopic cholecystectomy. RESULTS: Percutaneous transhepatic gallbladder drainage was performed successfully in all patients within 48 hours after clinical diagnosis of acute cholecystitis. Complications related to percutaneous transhepatic gallbladder drainage were bile leakage after tract dilatation noted in 2 patients (1.4%), and 20 (14%) patients had pain at the puncture site which radiated to the right shoulder during the procedure, but resolved spontaneously within an hour later. On admission, 102 (70%) patients presented as right upper quadrant pain, 39 (27%) as epigastric pain, 90 (62%) as fever, 108 (74%) patients had leukocytosis, and 33 (22.7%) patients were septic. AST and ALT were elevated in 57% and 51% of patients, respectively. Alkaline phosphatase was elevated in 56% of patients, and 34% of those patients had combined common bile duct stones. Gallbladder stones were documented in 135 (93%) patients, while the remaining 10 (7%) cases were acalculous. Five (3.4%) patients had combined gallbladder adenocarcinoma, 7 (4.8%) had liver abscess, while 13 (9%) had biliary pancreatitis. The ultrasonographic findings included gallbladder distension (93%), wall thickening (90%), pericholecystic fluid accumulation (15%), intraluminal sludge or stone (93%) and intraluminal air (13.9%). Bile culture were positive in 83% of the cases and showed gram-negative bacteria in 75%, gram-positive in 30%, anaerobes in 7%, while no growth in the remaining 17% of the cases. The common pathogens were Escherichia coli (57%), Enterococcus (27%), Klebsiella pneumonia (18%), Morganella morganii (7.6%), Pseudomonas aeruginosa (4.1%) and Salmonella (0.7%). The total postoperative complication rate was 17%, which included wound infection, bleeding, subhepatic abscess, cystic duct stump leak, common bile duct injury and pneumonia. Postoperative mortality was 2.6%. Conversion rate to open cholecystectomy was 27%. Clinical conditions improved within 48 hours after cholecystostomy in 93% of patients. Time interval between cholecystostomy and elective cholecystectomy was 2-21 days with a mean of 4 days. Total hospital stay was 5-38 days (mean: 11 days). CONCLUSIONS: Percutaneous transhepatic gallbladder drainage is a safe and effective procedure for the initial management of gallbladder empyema. We highly recommend this preoperative drainage procedure in patient with sepsis, and for those high-risk patients such as old age and with underlying medical illnesses. This procedure can stabilized the patient so that an appropriate therapeutic planning can be achieved.

Endoscopic sphincterotomy prior to laparoscopic cholecystectomy for the treatment of cholelithiasis.

BACKGROUND/AIMS: Laparoscopic cholecystectomy is the standard treatment for symptomatic cholecystolithiasis; however, there is debate on the management of patients with concomitant common bile duct stones. Several options have been suggested; endoscopic sphincterotomy and laparoscopic common bile duct exploration seemed to be the preferred methods at this moment. MATERIALS AND METHODS: We performed endoscopic sphincterotomy prior to laparoscopic cholecystectomy in 51 cases of acute symptomatic cholelithiasis. RESULTS: Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy procedure-related complication rate was 5.4%, including 1 pancreatitis, 1 cholangitis, and 2 major bleeds. After follow up period of 15-42 months, recurrent stones were found in 2 patients. CONCLUSION: Endoscopic sphincterotomy combined with laparoscopic cholecystectomy is a safe and effective therapy for symptomatic cholecystolithiasis with concomitant choledocholithiasis. Recurrent stones did occur, but further studies are needed to compare the incidence of recurrent stones after endoscopic sphincterotomy and after laparoscopic common bile duct exploration.

Diagnostic and therapeutic interventions in post-laparoscopic cholecystectomy biliary complications.

Radiological imaging and therapeutic interventions were performed in eight patients with biliary complications following laparoscopic cholecystectomy. The diagnostic approach and the outcome of the therapeutic procedures were evaluated. Complications observed were bile leakage from the cystic duct stump (n = 2); erroneous identification of the cystic duct leading to common hepatic duct transection (n = 1) and hepatic duct ligation (n = 2); liver abscess (n = 1); and retained common duct stones (n = 2). Diagnostic ultrasonography is capable of detecting the presence of abnormal fluid collection and the diameter of the common duct with or without the presence of a stone, although bile leaks and retained common duct stones can only be demonstrated by either endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography. Once a bile leak had been confirmed, therapeutic endoscopic biliary stenting was successfully applied in one patient while the other received percutaneous transhepatic biliary drainage. Definitive diagnosis of retained common duct stone was established by endoscopic retrograde cholangiopancreatography, and immediate endoscopic sphincterotomy with stone extraction was performed. Follow-up radiological imaging was done to determine the effectiveness of the therapeutic procedures applied in each patient. All our patients improved clinically, and further surgical intervention was not needed.

Therapeutic embolization of post-cholecystectomy hepatic artery aneurysm.

A "sandwich" technique employing steel coils and gelfoam embolization was applied in two cases of hepatic artery aneurysms. Immediate cessation of the bleeding was evident clinically and the post-embolization angiogram showed occlusion of the vascular lesion. Cholecystectomy is one of the most common abdominal operations and it is generally well tolerated, particularly in young and middle-aged patients. Morbidity rates of 5% to 32% and mortality rates of 0.4% to 2.5% have been reported, depending on such factors as age, underlying illness, etc. (1-4). The most frequent complications of cholecystectomy are wound infection, abscess, ductal injury or ligation, and bleeding. This paper describes two cases of hepatic pseudoaneurysm following iatrogenic damage during cholecystectomy which was treated with transarterial embolization.

Percutaneous transhepatic transluminal forceps biopsy in obstructive jaundice.

BACKGROUND/AIMS: To evaluate the technical feasibility and sensitivity of percutaneous transluminal forceps biopsy of bile duct diseases. MATERIAL AND METHODS: Seventeen fluoroscopic-guided transluminal forceps biopsies were performed in 16 patients with obstructive jaundice. The technique was performed through an existing percutaneous transhepatic tract. Multiple specimens were obtained after passing the forceps biopsy into a long 9-French sheath and the specimens were fixed with formalin for histopathologic diagnosis. RESULTS: Adequate samples for histological diagnosis was obtained in 12 of 17 procedures (sensitivity, 71%). Pathologic reports included pancreatic head carcinoma n = 2, cholangiocarcinoma n = 3, hepatoma with intrahepatic-bile duct invasion n = 3, common bile duct tumors n = 3 and chronic inflammation n = 1. Minor complications such as pain was noted in three patients while transient hemobilia was seen in two patients. CONCLUSIONS: Percutaneous transhepatic transluminal forceps biopsy is a safe technique which is easy to perform. This can be done through an existing transhepatic biliary tract with a sensitivity rate of 71%.

Rectal leiomyosarcoma diagnosed by endoscopic ultrasonography.

A 67 year-old man was admitted to the Tainan Municipal Hospital due to a protruding mass, usually noted during defecation. Digital examination revealed a single, smooth, large mass over the rectum, occupying almost the entire lumen. Colonoscopy, barium enema, and computed tomography (CT) demonstrated a submucosal tumor of the rectum. Endoscopic ultrasound (EUS) study showed that the tumor originated from the muscle layer. Based on the size, margin and echogenicity of the mass, a malignant neoplasm, probably leiomyosarcoma, was diagnosed. Post-operative histologic examination confirmed that the resected tumor was leiomyosarcoma. Existing ancillary procedures like colonoscopy, abdominal CT, magnetic resonance image (MRI), and barium enema are neither reliable nor accurate in locating which layer the lesion originates. Colonoscopic biopsy is disappointing since submucosal tumor is usually inaccessible. EUS study can provide us with a more distinct image with regards to tumor origin, size, margin and echogenicity. This report emphasizes the important role of EUS in the pre-operative diagnosis of submucosal tumors of the rectum. Furthermore, this tool can aid the surgeons whether wide excision or an abdomino-perineal resection should be performed.

Percutaneous cholangiofiberscopic endoluminal forceps biopsy of intrabile duct diseases.

BACKGROUND/AIMS: The aim of the present study was to determine the usefulness and sensitivity of percutaneous cholangiofiberscopic guided forceps biopsy in patients suspected of intrabile duct diseases. This study also emphasized the use of a video monitor system in which the field of view is magnified; thus, even a small lesion can easily be detected. Furthermore, coordination of both the operator and assistant is easier because both can observe the image together on the video monitor. METHODOLOGY: Percutaneous cholangio-fiberscopic forceps biopsy was performed in 27 patients (14 men, 13 women, aged 37-81 years with a mean age of 61 years). A mature T-tube tract was used as an access for cholangioscopy in 17 cases while the remaining 10 patients underwent percutaneous transhepatic biliary drainage and gradual tract dilatation from 7-French to 16-French. A flexible fiberoptic choledoscope was gently inserted into a mature tract and once an abnormal mucosal lesion was identified, a forceps biopsy was inserted into a working channel of the scope, and 3-5 specimens were taken for histological examination. RESULTS: A histological diagnosis was obtained in 24 cases of the 27 patients (sensitivity 89%) and included cholangiocarcinoma (n=8), papillomatosis (n=3), ampullary adenoma (n=1), ampullary adenocarcinoma (n=1), hepatoma with intrabile duct invasion (n=1), and chronic inflammation (n=10). Post-procedural bleeding was noted in 1 patient. CONCLUSIONS: Percutaneous cholangiofiberscopic-guided forceps biopsy is a safe and easy to perform procedure. It yielded a high sensitivity rate for definitive diagnosis of very small or early intrabile duct lesions; thus, a curative therapeutic modality can be appropriately applied. The use of a video monitor system, which magnified the field of view without distorting the quality of the image, plays a crucial role in this technique. Mucin substance is commonly seen in cholangiocarcinoma. The association between bile duct stones and neoplasm needs further evaluation.

Video-endoscopic ultrasonography in staging gastric carcinoma.

BACKGROUND/AIMS: Clinical staging of gastric carcinoma is important in designing the strategy of treatment. Early gastric carcinomas can be treated by minimally invasive therapy, whereas advanced gastric carcinomas should be treated by surgery with or without combined chemotherapy. This study was undertaken to evaluate the accuracy and limitations of video type endoscopic ultrasound in preoperative staging of gastric cancer and assessing lymph node metastasis. METHODOLOGY: Seventy-four patients with gastric carcinoma were preoperatively staged using video-endoscopic ultrasonography, performed by the same gastroenterologist. RESULTS: Sixty-three out of the 74 (85%) patients were correctly staged by endoscopic ultrasonography. The diagnostic accuracy rate was 100% for T1, 74% for T2, 87% for T3, and 86% for T4. Overstaging occurred in 11% due to peritumoral inflammation. Understaging occurred in 4% due to microinvasion of carcinomatous tissue or deeper organ invasion. The diagnosis of lymph node metastasis was confirmed in 72% of cases. Sensitivity and specificity was 74% and 86%, respectively. CONCLUSIONS: Endoscopic ultrasonography has a high accuracy rate in staging gastric carcinoma but still has its limitations in evaluating regional lymph node metastasis, despite using a new generation video-endoscopic ultrasonography.

Ultrasound-guided percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy: a new trial in the treatment of severe acute suppurative cholecystitis.

Seven cases of acute suppurative cholecystitis underwent percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy at the Tainan Municipal Hospital. All the patients had frank septic phenomena clinically, including fever, jaundice, leukocytosis and unstable blood pressure. Organisms were cultured from both blood and bile specimens. Ultrasound-guided transhepatic puncture of the gallbladder was performed for bile drainage, and laparoscopic cholecystectomy was subsequently performed two to five days later after the patients had stabilized. No procedure-related complications from either percutaneous transhepatic gallbladder drainage or laparoscopic cholecystectomy were observed. All patients had early recovery, shortened hospital stay and good cosmetic results. These preliminary results show that laparoscopic cholecystectomy is a safe method and can be employed in those patients with symptomatic gallstone associated with suppurative cholecystitis after preoperative biliary drainage.